72 PHYSIC 



rash, and consequently responsible for shaping its specific 

 features and determining its local incidence and char- 

 acter. Thus a simple miniature dermatitis, with only 

 the slightest surrounding hyperaemia, may be all that is 

 visible in arsenical or alcoholic neural elimination, or the 

 most acute and destructive changes may mark its rapid 

 progress over larger areas, a papular thickening, a vesicular 

 elevation, or a pustular invasion, may mark the points of 

 excretion of a bacterial organism, a bulbous accumulation 

 of neural lymph may represent arrested perspiration and 

 subcutaneous accumulation, a crusted and piled-up heap 

 of escaped medullary substance may be recognised in the 

 rash known as pemphigus, and the more sebaceous spots of 

 acne and the comedones of xanthelasma as admixtures of 

 the whole exuvial and excrementitious fibro-neural ele- 

 ments. When we add this large class of the more slowly 

 progressing eliminative ailments noticeable on, through, 

 or over the skin to the exanthemata proper, and when we 

 bring into the same category many of the diseases of the 

 olfactory apparatus, the glosso-pharyngeal area, and the anal 

 orifice of the intestinal canal, besides, it is conceivable, a 

 considerable proportion of the diseases attacking the 

 visceral parenchyma and limiting membranes within the 

 body, we must become aware of the great importance of 

 neural circulation and excretion in the incidence and evolu- 

 tion of the morbid entities to be met with in the human 

 body, and of the consequent necessity there is for a con- 

 tinual recognition of that fact in the everyday work of 

 diagnosis, prognosis, and treatment, both on account of 

 its inherent, immediate, and utilitarian value, and its 

 purely scientific bearings on the progress of medicine and 

 surgery locally and generally. 



Moreover, the incidence of cutaneous tuberculous affec- 

 tions, such as rodent ulcer, and even cancer itself, seem to 

 be to a great extent determined by neural distribution and 

 excretion, and the consequent effects of tainted neural 

 materials amid the textural elements undergoing malignant 

 change, hypertrophic growth, and degenerative removal, 

 in all which morbid phenomena it is warrantable to sup- 

 pose, and even to contend, that a subtle and destructive 

 poison is being distilled, and, it may be, a dynamic leakage 



